Active surveillance for prostate cancer.
Active surveillance for prostate cancer.
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DOI：
10.21037/tau-20-1370
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发表时间：
2021-06
影响因子：
2
通讯作者：
Carlsson SV
中科院分区：
文献类型：
--
作者：
Shill DK;Roobol MJ;Ehdaie B;Vickers AJ;Carlsson SV
许多被诊断患有局限性前列腺癌的男性可以推迟明确的治疗，而不会增加转移或因疾病死亡的风险。主动监测（AS）是一种监测特定男性的方法，可以选择在出现进展迹象时转向积极治疗，从而避免众所周知的手术和放疗副作用。本综述分析了长期运行的 AS 队列的数据，以确定 AS 的安全性和有效性。我们对最近发表的数据进行了叙述性回顾，其中包括来自 13 个 AS 队列的 14 篇文章。这些队列使用了不同的纳入标准，报告了临床 T 分期和格里森评分（等级组）等特征的差异。一些研究 (n=5) 将其队列限制为低风险患者，而其他研究 (n=8) 还包括中风险患者。队列的异质性产生了不同的结果，10 年前列腺癌转移风险为 0.1-1.0%，10 年前列腺癌死亡风险为 0-1.9%。然而，大多数研究报告 10 年内转移和死亡的风险均低于 0.5%。对于大多数队列，一半的男性在 5-10 年内未接受治疗，估计多伦多队列中 37% 的男性接受积极治疗，国际前列腺癌研究 AS (PRIAS) 研究中这一比例为 73%。目前的数据不支持使用负磁共振成像 (MRI) 来避免预定的活检。总而言之，从这些 AS 队列中收集的数据表明，对于患有低度前列腺癌的男性和一些患有中等风险疾病的男性来说，AS 是一种安全的方法。应更广泛地对符合条件的患者实施 AS，以避免因接受积极治疗而导致生活质量下降。需要扩大纳入标准并进一步定义可能从 AS 中安全受益的中危前列腺癌男性子集，以评估在中危人群中使用 AS 的长期结果。
Many men diagnosed with localized prostate cancer can postpone definitive treatment without raising their risk of metastasis or death from disease. Active surveillance (AS) is a method of monitoring select men, with the option of switching to active treatment upon signs of progression, thereby avoiding the well-known side-effects of surgery and radiotherapy. This review analyzes the data from long-running AS cohorts to determine the safety and efficacy of AS. We conducted a narrative review of recently published data, including 14 articles from 13 AS cohorts. The cohorts used varying inclusion criteria, with reported differences in clinical T stage and Gleason Score (Grade Group), among other features. Some studies (n=5) limited their cohorts to low-risk patients, while others (n=8) also included intermediate-risk patients. The heterogeneity of the cohorts produced mixed results, with the risk of prostate cancer metastasis ranging from 0.1–1.0% at 10 years and the risk of prostate cancer mortality ranging from 0–1.9% at 10 years. However, the majority of studies reported risks of less than 0.5% at 10 years for both metastasis and death. For most cohorts, half of men remained untreated for 5–10 years, with estimates ranging from 37% receiving active treatment in the Toronto cohort to 73% in the Prostate Cancer Research International AS (PRIAS) study. Current data do not support the use of negative magnetic resonance imaging (MRI) to avoid scheduled biopsy. Taken together, the data collected from these AS cohorts suggests that AS is a safe approach for men with low-grade prostate cancer and some men with intermediate risk disease. AS should be more broadly implemented for eligible patients to avoid the decreases in quality of life from undergoing active treatment. Studies expanding the inclusion criteria and further defining a subset of men with favorable intermediate-risk prostate cancer who might safely benefit from AS are needed to assess the long-term outcomes of using AS in intermediate-risk groups.
影响因子：
2
作者：
Menichetti J;Valdagni R;Bellardita L
通讯作者：
Bellardita L